Provider First Line Business Practice Location Address:
2701 E SLAUSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-6000
Provider Business Practice Location Address Fax Number:
323-588-0088
Provider Enumeration Date:
05/11/2017